Wiki Wrist arthrotomy

[bababrayer]

My provider did an open wrist joint exploration which leads me to codes 25040 & 25101. All he did was exploration. What would lead me to chose one code over the other?

Can anyone explain the difference between codes 25040 & 25101? I understand 25101 is for joint exploration; with/without biopsy, with/without removal foreign body. However the only difference I see between these codes is the word 'drainage' in code 25040.

In code 25040 do you need to perform exploration AND either drainage or foreign body removal or is any one of the 3 (exploration OR drainage OR foreign body removal).

I appreciate any and all feedback.

Thank you!!

 

[MI_CODER]

I believe that CPT 25040 is specifically for the radiocarpal or midcarpal joint while CPT 25101 is to be used as more of an "unspecified" wrist joint exploration. Below are the CPT lay descriptions for each code:

CPT 25040 - The physician performs an arthrotomy of a radiocarpal or midcarpal joint that includes exploration, drainage, or removal of any foreign body. An incision is made over the joint to be exposed. The soft tissues are dissected away and the joint capsule is exposed and incised. The joint space is explored, any necrotic tissue is removed, and infection or abnormal fluid is drained. If a foreign body is present (e.g., bullet, nail, gravel), it is exposed and removed. The wound is irrigated with antibiotic solution. The physician may leave the wound packed open with daily dressing changes to allow for further drainage and secondary healing by granulation. If the incision is repaired, drain tubes may be inserted and the incision is repaired in layers with sutures, staples, and/or Steri-strips.

CPT 25101 - The physician makes a longitudinal incision over the part of the wrist to be exposed (e.g., anterior, posterior, medial, or lateral aspect) to access the wrist joint and perform an arthrotomy. The soft tissues are dissected away to expose the joint capsule, which is incised to expose the synovium lying within the capsule. A small portion of the synovium is excised for biopsy in 25100. In 25101, additional dissection is carried out to further explore the joint cavity. Any loose or foreign bodies (e.g., free cartilage, bone chips, gravel) are removed and a biopsy may be taken. The physician irrigates the joint. The physician may leave the wound packed open with daily dressing changes to allow for further drainage and secondary healing by granulation. A drain tube may be placed and the incision repaired in layers with sutures, staples, and/or Steri-strips. A splint may be applied to limit wrist movement.

 

[bababrayer]

Just to clarify because I am getting this question...

In 25040 you can bill when only joint exploration is done? The lay description is confusing because it says "The joint space is explored, any necrotic tissue is removed, and infection or abnormal fluid is drained. Since there are commas and the word 'and' it sounds as if joint exploration and drainage must be performed to report code. Does anyone else read it this way?

I appreciate any feedback.

Thank you!!

 

[MI_CODER]

This is tricky and I see where you're coming from. This is how I read the CPT description for 25040, "Arthrotomy, radiocarpal or midcarpal joint, with exploration or drainage or removal of foreign body. I believe that if your provider is only performing an exploration of the radiocarpal or midcarpal joint then you are able to code CPT 25040. I believe the CPT lay description is just making sure to include each of those possible procedures that could be performed under this one CPT code.

 

[bababrayer]

This is tricky and I see where you're coming from. This is how I read the CPT description for 25040, "Arthrotomy, radiocarpal or midcarpal joint, with exploration or drainage or removal of foreign body. I believe that if your provider is only performing an exploration of the radiocarpal or midcarpal joint then you are able to code CPT 25040. I believe the CPT lay description is just making sure to include each of those possible procedures that could be performed under this one CPT code.

Thank you much!! I greatly appreciate your help.